Why the "Bo-Tax" Was Wrong, But Will Come Back | Plastic Surgery Confidential

Recently, the US Senate proposed, behind closed doors, the “Bo-Tax”- a tax on cosmetic surgery. Lead by several medical organization and Allergan, the manufacturer or Botox, it was actually removed from the final bill that the US Senate approved for Healthcare Reform.

For not so obvious reasons, this tax is a completely scary and stupid idea. No, I’m not going to defend my income as a plastic surgeon. These are things that should concern all consumers.

1- This tax allows the IRS to delve into the patient medical record to determine what is and what is not a cosmetic procedure. Right now, consumers/ patients enjoy tremendous privacy protection through the “doctor-patient relationship” and HIPAA. This tax would completely make a mockery of it, since the IRS may want to collect a tax on something that a patient submits as reconstructive.

As you are probably aware, the IRS often has audits on an individual or small business based on information given to the IRS by customers or others. Patients submitting routine documentation for a reconstructive procedure tax deduction may make their medical record liable to be examined by the IRS, just in the case the nature of the tax deduction comes into question.

2- The IRS would help determine what is and is not cosmetic. Maybe a bit alarmist, but the IRS is under no obligation to follow what the other Federal Government health agencies say about what is or is not a cosmetic procedure. If the IRS

3- What if your insurance company denies a request for reconstructive surgery? Does this denial make your reconstructive procedure suddenly cosmetic in nature? Several procedures come to mind, such as cleft lip revision as an adult, scar revision of pretty much any type, any reconstructive procedure where the insurance company can argue that the procedure does not increase function, but merely improves the overall appearance of the site of injury, and other procedures. Heck, you can argue that breast reconstruction after breast cancer surgery is “unnecessary”. A bit extreme? Who can divine what the IRS can and cannot do?

4- Doctors will become tax collectors. As you know, I emerged from the womb as a fully board-certified plastic surgeon. My 2nd ambition in life was NOT to become a tax collector. If the “Bo-tax” ever passes, then I may be forced to chase down patients on the behalf of the IRS for tax payments. Better yet, if I’m exceptionally lazy, I can just tell the IRS that a patient of mine owes me money for taxes, NOT for my surgical fee, and I can’t collect it. That would be a fun-filled conversation between the patient and the IRS.

I am convinced that this tax idea will not go away. Cosmetic patients, rightly or wrongly, are perceived as being wealthy and vain, and are a huge target for the politicians in the US for increased revenue.

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